Beginning in 2017-2018, U.S. News started using a new way of calculating rankings that made a new metric more valuable than any other metric. U.S. News has not done anything like this before. For heart programs, U.S. News used the “adjusted mortality rate” derived by a statistical model in the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD). They gave this model a weight of 20 percent of the final ranking. Because of this change, many programs across the country saw huge changes in rankings without huge changes in the programs’ actual services or outcomes.
We are who we have been for the last decade: a top-tier pediatric heart center dedicated to the best outcomes for every patient. We take the toughest cases. We share our innovations and our data. We believe in transparency as a driver of quality care for all patients.
The Importance of Transparency
The goal of ranking or rating systems is to make information about hospitals readily available so that patients and their families can make the best, most informed choice possible about where to get care. At Nationwide Children’s, we believe in making information about our program openly available. Sharing this information among other hospitals helps to improve quality and safety. We were one of the first pediatric centers to publish data publically and advocate for participation in the Society of Thoracic Surgeons Congenital Heart Surgery Database.
But what happens when an objective measurement like mortality is complicated by other factors? This is the question facing us today.
The Challenge of Analyzing Pediatric Heart Surgery Data
For adult patients who get heart surgery, the statistical analysis of mortality is pretty straightforward. Surgeons perform about a dozen standardized procedures on several million patients. For congenital heart surgery, it is not so straightforward.
Congenital heart surgeons perform more than 200 procedures on fewer than 1 million patients each year. Even the “same” procedure can be different from one patient to the next. Congenital heart defects don’t form identically in every patient. Additionally, some very sick patients need “simple” procedures. But they are at a higher risk because they are so sick. All of this makes analyzing data about congenital heart surgery outcomes a difficult job.
Introducing the STS CHSD Adjusted Mortality Rate Model for Comparing Institutions
Data from the STS CHSD was originally collected and shared as an internal quality improvement tool. It was designed to measure the performance of a single institution against the average of all participating institutions. To date, it has not been validated as a ranking tool to compare outcomes at one institution to outcomes at another.
Working Together for Transparency and Accuracy
We acknowledge that no model is perfect. However, the level of importance that U.S. News has given to this deeply flawed model impacts the rankings of programs that take on the most complex, high-risk cases. We have spent the last few years working with STS to improve the accuracy of the model and will continue to work with U.S. News to address our concerns with the weight this inaccurate model was given. We are not alone raising concerns about the model and the U.S. News process. Several other top-rated institutions have joined us in speaking publicly and privately about the changes needed to improve accuracy and usefulness of the data presented to the public.
Transparency of data is important. Accuracy of that data is paramount. Inaccurate data harms patients, families and the centers that serve them.
Dedication to Our Patients, Families and an Open Conversation
Our dedication to patient- and family-centered care is the foundation for our efforts to improve quality, data collection and reporting, and collaboration with national databases and registries. We thank you for the trust you place in our team and look forward to continuing to serve you.
Please consider this the beginning of an open conversation with us. We encourage you to ask questions. Call us, email us or talk to your medical team at your next appointment.